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Bartonella Infection. ARUP Consult®. Retrieved November 23, 2024, https://arupconsult.com/content/bartonella-species

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Bartonella Infection

Last Literature Review: July 2021 Last Update:

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Brian R. Jackson, MD, MS
Brian R. Jackson, MD, MS
Adjunct Professor of Pathology and Biomedical Informatics, University of Utah
Medical Director, Business Development, ARUP Laboratories

Bartonella species bacteria cause a range of diseases, including cat scratch disease (CSD), caused by B. henselae; trench fever, caused by B. quintana; Carrión disease (Oroya fever and verruga peruana), caused by B. bacilliformis; and bacillary angiomatosis (BA), caused by B. henselae and B. quintana. , , ,  In some cases, subacute endocarditis may also be caused by Bartonella spp.  Diagnosis of these diseases is based on clinical evaluation, patient history, and laboratory testing. Laboratory evaluation may include serology, nucleic acid amplification testing (NAAT), and culture. , , 

Quick Answers for Clinicians

How are Bartonella infections transmitted?

Cat scratch disease (CSD) is transmitted through the scratch of domestic or feral cats carrying fleas infected with Bartonella henselae. Diagnostic testing for CSD may be appropriate for patients exhibiting CSD symptoms with previous exposure to cats and recent scratch history. Trench fever is transmitted by the human body louse. Testing for trench fever may be appropriate in patients with characteristic symptoms who are at an increased risk for human body lice (eg, persons experiencing homelessness or living in areas with poor sanitation). Carrión disease is transmitted through female sand flies, primarily in high-elevation areas of the Andes Mountains, and should be considered in patients who have traveled to that region or have been in contact with someone who has traveled to that region. 

Which symptoms might prompt testing for Bartonella?

Cat scratch disease (CSD) is often characterized by low-grade fever, enlarged and/or tender lymph nodes (1-3 weeks postexposure), and a papule or pustule at the scratch site. In some cases, infection may develop in the bones, eyes, brain, liver, heart, or spleen. Trench fever generally presents with fever (one time or relapsing), headache, rash, and bone pain. Carrión disease occurs in two distinct phases. The first, Oroya fever, may include symptoms such as fever, headache, muscle aches, and abdominal pain. The second phase, verruga peruana (Peruvian warts), is characterized by the formation of growths under the skin that develop into red to purple vascular sores. Bacillary angiomatosis (BA) occurs most frequently in people with weakened immune systems (eg, patients with advanced HIV infection) and may result in fever, bone pain, or lesions of the skin, bone, or other organs. 

Because Bartonella symptoms are often generalized, the testing strategy should also be informed by patient history. 

Indications for Testing

Testing for Bartonella species is appropriate in patients with a compatible exposure history and typical signs and symptoms of CSD, trench fever, Carrión disease, BA, or subacute endocarditis.

Laboratory Testing

The laboratory diagnosis of Bartonella infection generally includes serology, NAAT, and culture. The laboratory testing strategy depends on the suspected etiology of disease. , , 

Serology

Serology may be useful to confirm diagnosis of CSD and trench fever, including current and past exposure to Bartonella spp. Low sensitivity and cross-reactivity between Bartonella spp may complicate diagnosis in some cases. ,  After infection, serologic results may be persistently positive for years, even following effective treatment. ,  Observation of seroconversion between paired acute and convalescent sera is considered strong evidence of recent infection. Because diagnosis via serology requires collection of convalescent serum, treatment should not be delayed while waiting for laboratory test results. 

Polymerase Chain Reaction Testing

Polymerase chain reaction (PCR) testing may be useful for the diagnosis of CSD, trench fever, and BA, including in patients with culture-negative endocarditis. PCR assays are generally appropriate for tissue or blood samples. The sensitivity of molecular testing is often low in blood samples. Other specimen types may be appropriate under specific circumstances. Patients undergoing valvular replacement should be tested via PCR using heart valve tissue. ,  Lymph node aspirates can be tested by PCR, but collection of this specimen type is recommended only when the diagnosis is unclear or when lymph node aspiration is being considered to reduce pain and swelling.  Testing of cerebrospinal fluid (CSF) can also be considered.

Many PCR assays do not differentiate between Bartonella spp, which might complicate treatment selection. The sensitivity of molecular testing decreases as time from the initial infection increases.

Culture

Bartonella culture can be technically challenging and requires at least 21 days of incubation. Blood or tissue culture may be useful for the diagnosis of CSD, trench fever, Carrión disease, and subacute endocarditis. , , 

Other Testing

A peripheral blood smear can be used to diagnose Carrión disease during the Oroya fever phase. 

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References